Water during labour and birth

Options for labour and birth have expanded over recent years. You can choose between different health care providers and different birth places. You can choose an active birth, a Leboyer birth and now you can choose a waterbirth. The use of water has become increasingly popular as a way of avoiding a high tech birth both in hospital and at home. While the use of water during labour is common place, giving birth to a baby under water is more controversial

A woman can use water during labour and birth in a number of ways. These include:

A shower

Hot towels

Submerging in a bath

Submerging into a deep pool of water

Some women feel very comfortable in the water during labour and decide to stay in the water to give birth. Giving birth under water raises many questions - How safe is it? Does research support waterbirth? Does water provide effective pain relief? What precautions should be used if a woman labours and/or gives birth in water? Water, as with many issues during pregnancy and birth, is not very well researched. There needs to be a lot more research before we can accurately answer these and other questions. Some evidence however, is slowly gathering from around the world on the use of water during labour and birth. In the future we will know a lot more.

Waterbirth concerns many people. One common fear is that the baby will drown if born into water. The baby born into water has a diving reflex that helps prevents the inhalation of water into its lungs. Once the baby is exposed to air the receptors in the baby’s face triggers the baby’s breathing. Because of these factors, once the baby is born into water it should be brought gently to the surface and the baby’s face must not be resubmerged under the water.

To make sure that the baby does not get cold after the birth - the baby’s body can stay under the water and the baby’s head can be dried with a warm towel. If the baby is well he/she can stay with their mother in the water. Whether or not to permit the placenta to be born in the water in the water is another controversial issue. There are some theoretical risks to remaining in the water, however none have ever been proven. Some health care practitioner encourage women to leave the water for the third stage of labour while others are happy for women to remain in the water. If bleeding after the birth seems excessive the woman would be asked to leave the water.

I have heard that using water during labour is helpful, can you explain the reasons why?

Using water during labour and birth encourages:

Reduction in pain

Greater mobility that comes with buoyancy

Induces relaxation

Reduction in abdominal pressure

Softening effect on the perineum and vulva can promote stretching during crowing

Gentle entrance into the world for the baby

One of the most common finding of research is that many women find that being submerged in water enables them to relax and they find the pain of labour lessens. In one study, where women used water during labour only, they found that 80% of the women reported that they would like to use water next time they were in labour.

I like the idea of using water during my labour. I would like to know if it is safe for my baby to be born underwater?

Until more research is completed, we cannot say with any accuracy whether there are any risks associated with the use of water during labour and birth. The limited evidence that is available so far indicates that waterbirth is thought to be safe so long as some simple, sensible guidelines are followed. These guidelines include:

A skilled practitioner in waterbirth is available

The pool or bath has been thoroughly cleaned and rinsed

A normal labour and birth is expected.

The water temperature is not too hot (<36 degrees Celsius)

The woman is at least 6 cm dilated (hoping before this time is thought to slow labour)

The woman is well hydrated. It is important to drink lots of fluids when in the water, as dehydration can be a problem

There are no additives put in the water (these are not helpful and some are potentially harmful)

The baby is brought to the surface as soon as it is born

The use of water is not appropriate if a woman has a fever, there is meconium in the waters, the baby’s heart rate is abnormal or if the woman has had any abnormal bleeding. As more evidence is revealed, we will know more about the safety or otherwise of water during labour and birth.

I have decided that I would like a waterbirth. Can you tell me how I could organise one?

This will depend on the place that you plan to give birth. A water birth is easily arranged at home. A large bath can be used or it is possible to hire or buy a pool suitable for a water birth. If you plan to give birth in a hospital you will have to find out what facilities are available and what their policies are regarding waterbirth. Some hospital facilities have a waterbirth policy all ready in place. Where as others have not had a request for a waterbirth before. Achieving a water birth will also depend on the skills of the midwife or doctor providing your care. If they are not confident with water birth - they may prefer that you give birth on dry land. Most hospital facilities do have water available for use during labour eg. shower, bath or pool.

Setting up a pool at home or in a hospital requires some forethought. Is there space enough for the pool? How will the pool be filled and emptied? Is the hot water service adequate? Is the pool a good height and width? Is the pool comfortable? Are you able to lean on the sides of the pool without it collapsing? Is the floor able to take the weight of a pool filled with water?

Make sure that there is safe heating in the room, remember electricity and water do not mix. The following items are helpful for when planning a waterbirth:

A bath thermometer - this can be used to ensure that the water temperature is not getting too hot.

A plastic strainer and a bucket - to be used for removing debris from the pool.

Lots of warm towels for mother and baby.

A space for you to use - in case you decide to leave the pool at any stage.

I would like to find out more about waterbirth. Are there websites or books that I could find further information?

There are a wide range of books on the market that explore the use of water during labour and birth.

Choosing Waterbirth (2000) Lakshmis Bertram

Choosing a waterbirth (1998) Beverley Lawrence Beech

Waterbirth Unplugged (1996) Beverley Lawrence Beech

Water labour Water birth - AIMS

Water birth: The concise guide to using water during pregnancy, birth and infancy - Janet Balaskas and Yehudi Gordon

These are just some of the books available. You can obtain some of these books through your local bookshop or you can contact two specialised book stores for a free catalogue:

Jane Palmer is a mother, birth activist and midwife in private practice located in Sydney, Australia. With additional qualifications as a childbirth educator and lactation consultant, Jane works to improve pregnancy, birth and parenting options for families.